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Assessing officer (AO code) Sign with black ball point pen within the below box
Area code AO type Range code AO No.
Sir, I/We hereby request that a permament account number be alloted to me/us.
I/We give below necessary particulars:
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
First Name
Middle Name
7 Address
Residence Address
Flat / Room / Door / Block No.
HOUSE NO -117
Name of Premises / Building / Village
bansgaw
Road / Street / Lane / Post Office
bansgaw
Area / Locality / Taluka / Sub- Division
BASTI
Town / City / District
BASTI
State / Union Territory
UTTAR PRADESH
Pincode / Zip code
272170
Office Address
Name of office
Full name, address of the Representative Assessable, who is assessable under the Income Tax Act in respect of the person, whose particulars have been given in
the column 1-13,
First Name
Middle Name
Address
Residence Address
Flat / Room / Door / Block No.
I/We have enclosed AADHAAR CARD ISSUED BY UNIQUE IDENTIFICATION AUTHORITY OF INDIA as proof of
identity and AADHAAR CARD ISSUED BY UNIQUE IDENTIFICATION AUTHORITY OF INDIA as proof of address.
[Please refer to the instructions (as specified in Rule 114 of I. T. Rules, 1962) for list of mandatory certified documents to
be submitted as applicable]
16 I/We PRADEEP KUMAR CHAUDHARY , the applicant, in the capacity of HIMSELF do hereby declare that what is
stated above is true to the best of my/our information and belief.
Place BASTI Date 21-05-2018 Sign with black ball point pen within the below box
Instructions for New PAN Application
Reference No: 2018051915960
Documents to be attached
PAN Services,
Applypanonline.com,
57/28, First Floor, IV Main Road,
C.I.T. Nagar, Chennai - 600035.
APO